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PEDIATRICS Vol. 112 No. 3 September 2003, pp. 514-520

Trends in Otitis Media Among Children in the United States

Peggy Auinger, MS^*, Bruce P. Lanphear, MD, MPH, Heidi J. Kalkwarf, PhD and Mona E. Mansour, MD, MS

^* Department of Pediatrics, University of Rochester School of Medicine and Dentistry and the American Academy of Pediatrics Center for Child Health Research, Rochester, New York
Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

Background. The prevalence of repeated otitis media (OM) increased during the 1980s, but it is unknown if the increase has continued.

Objectives. To determine trends in the prevalence of OM, early-onset OM, and repeated OM among US children from 1988 to 1994 and to identify factors that may explain any observed changes.

Methods. The Third National Health and Nutrition Examination Survey was administered in 2 phases: phase I (1988–1991) and phase II (1991–1994), each comprising a national probability sample. OM (ever having had OM), early-onset OM (first episode at <12 months of age), and repeated OM (3 episodes) were assessed for 8261 children <6 years of age.

Results. After controlling for risk factors for OM, the prevalence of OM from phase I to phase II increased from 66.7% to 69.7% (odds ratio [OR] = 1.1; 95% confidence interval [CI] = .99, 1.1), early-onset OM increased from 41.1% to 45.8% (OR = 1.1; 95% CI = 1.03, 1.2), and repeated OM increased from 34.8% to 41.1% (OR = 1.2; 95% CI = 1.1, 1.4). This observed increase corresponds to 561 000 and 720 000 more children having early-onset OM and repeated OM, respectively. Child care use, early breastfeeding termination, asthma, and access to health care did not significantly increase from phase I to phase II. The prevalence of early-onset OM and repeated OM was higher for affluent children, but the greatest increase in prevalence was among impoverished children. There was an increase in allergic conditions from phase I to phase II for poor children (22.6% to 30.2%).

Conclusions. The prevalence of early-onset OM and repeated OM continued to increase among preschool children in the United States. Further research to investigate this increasing prevalence should explore changes in management practice and an increase in prevalence of allergic conditions among poor children.

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Key Words: otitis media • early-onset otitis media • National Health and Nutrition Examination Survey • allergy • epidemiology • pediatric • children

Abbreviations: OM, otitis media • NHANES III, Third National Health and Nutrition Examination Survey • OR, odds ratio • RR, relative risk • CI, confidence interval

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Received for publication Sep 17, 2002; Accepted Feb 20, 2003.

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